COMPANY

Minnesota Legislative Auditor Reviewing MNsure Problems

Scrutiny increases on Minnesota health exchange after lost applications, long wait times.

by CHRISTOPHER SNOWBECK, MCCLATCHY NEWS SERVICE
/
January 7, 2014

Minnesota's legislative auditor said Monday that probes are needed to detail all the problems at MNsure and to find out why troubles that blocked people from getting health insurance weren't identified more quickly.

The comments from auditor Jim Nobles came at the start of a week that's likely to include more MNsure scrutiny, with a legislative oversight committee set to meet Thursday at the Capitol.

Last week, state officials released a December letter from Gov. Mark Dayton detailing extensive problems with MNsure's software that prevented many from using the health exchange website and forced them to wait hours for help from an overwhelmed call center.

One problem involved a "black hole" in which applications were irretrievably lost, although a MNsure official Monday suggested the issue was being addressed.

"Given all of the problems that have occurred, I think everybody deserves a thorough, independent examination of what went wrong," Nobles said Monday. "Why didn't the state identify these problems earlier and ensure that they got corrected?"

Minnesota launched the MNsure health exchange to implement the federal Affordable Care Act, which requires almost all Americans to have health insurance this year or pay a tax penalty.

The federal government has backed MNsure with about $150 million in grants, including about $70 million spent during the 12-month period that ended in June, Nobles said. The size of the expenditure last year automatically triggers an audit, Nobles said, adding that the review is scheduled to begin Tuesday.

Nobles said he's also planning a review of information technology security measures on the MNsure website and wants to launch a third probe of the overall health exchange project. The investigation would look at MNsure's contracts with software vendors, the effectiveness of the agency's management and its governance structure, Nobles said.

Both Dayton and a top Republican in the Legislature said Monday that they supported a Nobles review.

"A full, independent examination of MNsure is highly appropriate," Dayton said in a statement.

The audit is needed because "the governor and the commissioners that are responsible for oversight were not engaged until things got very bad for Minnesotans," said state Sen. Michelle Benson, R-Ham Lake.

As of Dec. 31, nearly 68,000 Minnesotans had used the MNsure website to sign up for public or private health insurance coverage. State officials have a goal of connecting 135,000 people with coverage by March 31, when the current open-enrollment period ends.

The federal law imposes a tax penalty on people who lack coverage but includes a three-month grace period when fines won't apply.

After the MNsure website launched Oct. 1, health exchange officials offered an upbeat commentary on the number of people who've selected a private health insurance plan or determined eligibility for income-based health insurance programs run by the government. But in the past six weeks or so, officials have acknowledged a growing list of problems.

In late November, state officials said they'd have to rerun 30,000 applications because the system was wrongly determining whether applicants were eligible for federal tax credits or state-sponsored insurance. In December, wait times at the MNsure call center ballooned as consumers struggled to overcome glitches on the health exchange website.

About 1,000 applicants were told in late December that they'd have to delete their applications and start over. Another 1,100 applications were lost in the system and required rescue from computer limbo.

State workers spent the holidays typing in more than 2,000 paper applications that couldn't be handled electronically, while manual processing also was required for another 2,000 applications that suffered from a software glitch.

Dayton's letter in December pinned blame on IBM Curam, which is one of four software vendors to MNsure. It preceded a "tech surge" in which IBM dispatched dozens of workers to St. Paul to tackle the problems.

An attachment to Dayton's letter described how thousands of applications had been landing in a "dead message queue or a process instance error (PIE) queue."

"Clients submit an application online, and potentially even enroll and pay for a plan, but we have no record of them in the eligibility system," the attachment stated. "There are over 2,600 of these in the PIE (queue), and Curam cannot tell us how many are cases or just error messages. ... They cannot get them out of this black hole."

Asked Monday about these applications, MNsure spokeswoman Jenni Bowring-McDonough wrote in an email: "The ... queue has been cleaned out, and all cases either moved into the case worker part of the system or deleted, and the consumer contacted."

It was unclear, however, whether that means consumers found coverage.

Bill Fleming, 39, of White Bear Township doesn't know if his application wound up in the black hole referenced by Dayton. But MNsure told him Dec. 30 the application was lost, and couldn't be found in time for Fleming and his family to have coverage through the exchange on Jan. 1.

"The recommendation was that I purchase directly through the insurers," Fleming wrote Monday in an email. "The timing made it impossible for me to shop around. ... I am maintaining our existing (coverage) for January, with the hope that I am able to confirm any credits and purchase through the exchange by Jan. 15."

If Fleming can get the situation resolved by then, his family's coverage would take effect Feb. 1. He wonders, though, if out-of-pocket costs his families might incur in the meantime would, in effect, be "wasted." That's because the costs would go against the deductible on his current policy, rather than the deductible for the policy he still hopes to buy on the health exchange.

"We have had extreme medical costs the past two years," Fleming wrote. "So my hope is to avoid expenses for January where we would be wasting deductible credit to the extent we are able to enroll in a more competitive plan effective Feb. 1."

As part of his investigations, auditor Nobles said Monday he hopes to clarify whether MNsure currently is able to verify the income that website users have been reporting when they apply for financial assistance. Based on the self-reported information, MNsure assesses whether people qualify for public health insurance programs or for federal tax credits.

"If we don't have a mechanism of doing the verification, many people would rightly be concerned that we've opened ourselves up to a good deal of fraud, frankly," Nobles said. "But we also want to make sure that people who are entitled to coverage have coverage."